According to World Health Organization (WHO), there are 80% of maternal mortality caused by complication during pregnancy, childbirth, and post-childbirth. From all numbers of maternal mortality rate, 99% of them occurred in developing countries[1]. In Indonesia, the main causes of maternal mortality are hemorrhage and infection. Hypertension case also increases than hemorrhage and infection which have lower proportion. In 2013, >25% of maternal mortality in Indonesia was caused by hypertension[2].

Hypertension during childbed consisted of blood pressure before 20 weeks of gestational age called as chronic hypertension. It is caused by pregnancy or gestational hypertension and acute hypertension during childbed[3]. Medicine category - Calcium Channel Blocker is effective. For example nifedipine which is able to decrease blood pressure. However, there are several side effects caused by myocard ischemia, hypotension, and peripheral edema[4]. The side effects of herbal medicine are lesser than conventional medicines. Therefore, the use of non-pharmacology medicine is saver than pharmacology medicine.

Medicine administration for postpartum hypertension could have effects, such as nausea, headache, abdominal pain and even excretion of breast milk. Previous studies showed that consuming garlic could influence blood pressure digression on hypertension patients[5]. Malodialdehyde (MDA) is lipid peroxide product containing aldehyde substance. It describes stress level. An oxidant is usually administered as biological biomarker of lipid peroxide. Lipid peroxide could be prevented by antioxidant[6]–[8].

Previous findings showed garlic administration and black cumin powder significantly decreased MDA plasma level on postmenopausal women[9]. Therefore, the effect of garlic administration based on pathophysiology of this research has purpose to prove the use of garlic extract (Allium sativum) as an alternative of blood pressure and malodialdehyde (MDA) level of post-partum mothers at Bhayangkara Prof. Awaloedin Djamin Hospital Semarang.

The data analysis was used to analyze the differences in blood pressure digression and MDA level between two group pairs using mann whitney test. Meanwhile, to analyze the difference of blood pressure digression and MDA between before and after intervention of the teams used friedman test and pos hoc Wilcoxon.

The Garlic Extract to Systolic and Diastolic Blood Pressure of Post-Partum Mother on both Intervention and Control Groups

^b Mann Withney test ^a Wilcoxon test ^c t-Independent-test

Table 3. Average of Systolic Blood Pressure

The differences of systolic blood pressure digression average on both teams could be seen on Figure 1.

Figure 1 explains the digression with amount 38 mmHg of first measurement until sixth measurement of systolic blood pressure of intervention group after the intervention with 681.6 mg dose. Meanwhile, the average of systolic blood pressure on control group had deviation 14.79 mmHg. Thus, it is concluded that the deviation of systolic blood pressure was 23.21 on both groups.

Table 3. Average of Diastolic Blood Pressure

Based on the measurement, there were two terms – systolic and diastolic blood pressure. Theoretically, it has not been known the main cause of hypertension on post-partum mother. Thus, there is a need of further investigation to detect and understand its etiologic to implement it. Therefore, hypertension of post-partum mother still becomes subject to be investigated. Post-partum hypertension is increasing blood pressure condition ≥140/90 mmHg without proteinuria or oedema post-partum[10], [11].

Review of post-partum hypertension in this research was limited, focused on post-partum period (2-6 days) in describing patients’ condition during inpatient. Then the data analysis is sent back again to the hospital due to suffer hypertension, preeclampsia, eclampsia, or other complication related to hypertension . Heretofore, the parturition case is considered as complex theory, neurologic influence, uterus circulation, nutrition and other factors causing parturition[12], [13]

Based on statistic test of the research done by Junaedi et al about garlic brew therapy which significantly decrease systolic and diastolic blood before and after intervention with p value 0.000. It means garlic was effective to decrease blood pressure[14].

Based on mann withney test during six day observation to monitor systolic blood pressure of intervention and control groups, it gained p-value from the first until sixth day P < 0.05. It meant that both teams had systolic blood pressure digression. Meanwhile, on blood pressure measurement showed there was no difference of diastolic blood pressure from the first until fourth day. The diastolic pressure showed P<0.05 seen on day 2, 3, 5, and 6 for both groups. The substance of garlic became effective oxidant to remodel hypertension patients; arteries[15].

Previous studies stated that garlic had pharmacological effect. It had many components contained in garlic. It was not known for sure the dominant component influencing blood pressure. It needed certain substance separation technique which was based on observation to decrease systolic and diastolic blood pressure. That was by administering allicor with 600 mg/day dose[16]. The content of garlic had important roles to prevent cell and organ’s destruction due to oxidation process[17]. Research dealing with this substance also showed bioactive substance as ingredient in pharmacological medicine or in health field, such as sesqueterpen[18].

Dealing with MDA level measurement between pre and post intervention of both teams, it gained p value > 0.005. It meant there was no significant difference of garlic extract to decrease MD level for both groups. The deviation of MDA level of both groups were 238, 86±131,89 ng/mL and MDA level of post intervention 265,86±123,30 ng/mL. Meanwhile, the MDA levels of control group before intervention were 491,36±551,83ng/mL and MDA after intervention 534,866± 473,03 ng/mL with p value 0,124.

There were many negative factors caused by free radiations. Based on the previous findings, the effect of garlic and black cumin significantly decreased MDA [9]. Oxidative pressure is an imbalance condition between cell antioxidant and higher cellular ROS level. Based on the findings done by Rini et al, they analysed chemical compositions of reminiscence leaves which contains oxidized sesqueterpen[18]. The present study about garlic has 15 top detected substances. They were known to produce oxidized sesqueterpen substance such as cubenol, t-muurolol and ά-cadinol. The latest study found garlic had terpen substance on top detected substances, such as guaiol. In different research by Roberto and Burits, they reported that detected substances in several TBARS test methods as prevention of free antioxidant effect significantly[19], [20].

Garlic also contributes as antioxidant but it has smaller area extension percentage. The role of the substance is important since it has potencies to cure disease caused by reactive species which were excessively produced.

The non-pharmacological hypertension cure such as garlic has biological effect, such as an antioxidant. MDA as indicators of free radiation could be prevented by antioxidant[21]. However, free radiation could be also triggered by stress and excessive activities[22]. Research about this substance showed that bioactive substance as ingredient for pharmacy (medicine) or its uses in health such as sesqueterpen[18] .

The administration of garlic could suppress blood pressure level of post-partum mother into normal condition. Meanwhile, based on this research, there was no different MDA level between pre and post condition of both groups.

Active responses of childbed mothers in seeking and accessing health information could control hypertension occurrence and free radical exposures. Operationally, due to innovation found in this research with principle to add garlic extract could be an alternative of post-partum mothers’ blood pressures. Besides that, it is expected for future researcher to pay attention in giving optimal dose and considering to use larger sample with longer investigation period. Furthermore, to control causal external factors such as stress due to psychological experiences of the mothers, could be expected to be investigated and reviewed completely.

[1]WHO UNICEF UNFPA, “WHO | Trends in maternal mortality: 1990 to 2010,” vol. 2015, 2014.

[2]Badan Penelitian, “Riset kesehatan dasar,” Riskesdas, vol. 13, pp. 1–384, 2013.

[3]R. I. Kemenkes, “Profil kesehatan Indonesia tahun 2016.,” in Kementerian Kesehatan Republik Indoesia, Jakarta:, 2016.

[4]S. C. Gad, “Calcium Channel Blockers,” Encycl. Toxicol. Third Ed., pp. 621–624, 2014.

[5]S. S. Noviantari D, “Penurunan Tekanan Darah Pada Penderita Hipertensi Di Desa Demangrejo , Sentolo , Naskah Publikasi,” Univ. ’Aisyiyah Yogyakarta, 2009.

[6]I. Juránek, D. Nikitovic, D. Kouretas, A. W. Hayes, and A. M. Tsatsakis, “Biological importance of reactive oxygen species in relation to difficulties of treating pathologies involving oxidative stress by exogenous antioxidants,” Food Chem. Toxicol., vol. 61, pp. 240–247, 2013.

[7]D. M. Radomska-Les̈niewska et al., “Reactive oxygen species and synthetic antioxidants as angiogenesis modulators: Clinical implications,” Pharmacol. Reports, vol. 68, no. 2, pp. 462–471, 2016.

[8]M. Sardarodiyan and A. Mohamadi Sani, “Natural antioxidants: sources, extraction and application in food systems,” Nutr. Food Sci., vol. 46, no. 3, pp. 363–373, 2016.

[9]R. M. Mostafa, Y. M. Moustafa, Z. Mirghani, G. M. AlKusayer, and K. M. Moustafa, “ Antioxidant effect of garlic ( Allium sativum ) and black seeds ( Nigella sativa ) in healthy postmenopausal women ,” SAGE Open Med., vol. 1, p. 205031211351750, 2013.

[10]E. Kang et al., “Prevalence, risk factors and associated complications of postpartum hypertension in rural Haiti,” Pregnancy Hypertens., vol. 10, pp. 135–142, 2017.

[11]G. Mc Lean, O. Reyes, and R. Velarde, “Effects of postpartum uterine curettage in the recovery from Preeclampsia/Eclampsia. A randomized, controlled trial,” Pregnancy Hypertens., vol. 10, pp. 64–69, 2017.

[12]H. Amagase, B. L. Petesch, H. Matsuura, S. Kasuga, and Y. Itakura, “Recent advances on the nutritional effects associated with the use of garlic as a supplement,” J. Nutr., vol. 131, no. May, p. 955S–962S, 2001.

[13]P. Phogat et al., “Introduction to Hyperlipidemia and Its Management: A Review,” Pharmacologyonline, vol. 2, pp. 251–266, 2010.

[14]Junaedi Edi et al, Hipertensi kandas berkat herbal. FMedia, 2013. FMedia, 2013.

[15]Hernawan et al Udhie Eko; Setyawan, “Senyawa organosulfur bawang putih (Allium sativum L.) dan aktivitas biologinya.,” Biofarmasi, vol. 1(2), pp. 65–76, 2003.

[16]L. G. Tereshchenko, E. Z. Soliman, B. R. Davis, and S. Oparil, “Risk stratification of sudden cardiac death in hypertension,” J. Electrocardiol., vol. 50, no. 6, pp. 798–801, 2017.

[17]A. Capasso, “Antioxidant action and therapeutic efficacy of Allium sativum L.,” Molecules, vol. 18, no. 1, pp. 690–700, 2013.

[18]Rini P et al“Kualitas, komposisi kimia, dan aktivitas antioksidan minyak kenanga (,” no. 1, pp. 3–11.

[19]M. Burits, K. Asres, and F. Bucar, “The antioxidant activity of the essential oils of Artemisia afra, Artemisia abyssinica and Juniperus procera,” Phyther. Res., vol. 15, no. 2, pp. 103–108, 2001.

[20]G. Ruberto and M. T. Baratta, “Antioxidant activity of selected essential oil components in two lipid model systems,” Food Chem., vol. 69, no. 2, pp. 167–174, 2000.

[21]H. R. M. Howes and Edisi1, “2006. Hydrogen Peroxide and Antioxidant Vitamin A, C, & E.,” LA: The Pundit Publishing Company, 2006, pp. 9–270.

[22]J. Wikana, “Pemberian kompleks buah berry menurunkan stress oksidatif dan meningkatkan pertahanan oksidatif pada perokok aktif,” Tesis). Universitas Udayana. Denpasar, 2011.